Showing posts with label neonatology. Show all posts
Showing posts with label neonatology. Show all posts

Friday, October 16, 2015

Familiar with Early-Onset Neutropenia in a Small for Gestational Age Infant? After Reading a New Study You Will Be!

By: Lewis First, MD, MS; Editor-in-Chief      


        Small for gestational age (SGA) infants are known to have early neutropenia when compared to normal size infants at a gestational age—but just what do we know about this neutropenia?  How common is it? How long does it last?  What might be causing it and what makes it better?  
       These questions and more are answered in an informative study by Christensen et al. (doi: 10.1542/peds.2015-1638) being released this month in our journal who looked at ten years of neutropenia in the first week of life in more than 200 SGA infants out of 3600 studied compared to less than 50 out of 3650 non-SGA infants.  The authors looked at a variety of factors associated or not-associated with this neutropenia ranging from necrotizing enterocolitis to thrombocytopenia and give us a much clearer picture of what the “neutropenia of SGA” is all about.  
        If you want to know more about a common finding in your SGA newborns and what to follow and worry about (or not) in this neutropenic population, then reading this study should be an easy “cell.”

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Tuesday, July 7, 2015

Understanding Morbidity and Mortality Concerns When Multiple Gestations Are Born Extremely Preterm

By: Lewis First, MD, MS; Editor-in-Chief 
 
     We are certainly aware of a myriad of potential complications that can occur to an extremely preterm infant and are grateful that our neonatology colleagues are there to help as needed.  But what if a mother in your practice gives birth to twins or triplets at an extremely preterm gestational age?  What advice do you give that family when they ask if this makes things better or worse for each individual twin or triplet infant?   
     Yeo et al. (doi: 10.1542/peds.2015-0479) share with us the results of a retrospective study of more than 15,000 infants born at or less than 27 weeks gestation from 1995-2009 into the Australian and New Zealand Neonatal Network in which singletons are compared to multiple gestation births in this preterm cohort.  There is a lot of data worth paying attention to in this study, with good news and bad news for multiple gestation infants compared to singletons born extremely preterm.  The bad news is that not unexpectedly, the odds of mortality in infancy are greater for multiples than for singletons across the 15 years studied.   
     The good news is that thanks to ongoing advances in neonatal care and technology, the odds of a poor outcome over the most recent 5 years studied is no different for multiple compared to single extremely preterm births.  If you are asked to care for a family expecting twins or triplets, and want to help them better understand what the future might hold if the babies are born earlier than expected, then labor a bit over this interesting study and deliver what you have learned in a way that hopefully will reassure expectant parents of multiple gestations as much as possible.

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Wednesday, July 1, 2015

Umbilical Cord Milking or Delayed Cord Clamping in Preterm Infants: Which Results in Better Systemic Blood Flow in Newborns?

By: Lewis First, MD, MS; Editor-in-Chief  

          When it comes to improving systemic blood flow in preterm infants, recent recommendations (doi: 10.1542/peds.2013-0191) point to delayed cord clamping as a preferred method of placental transfusion.  Yet other studies suggest that if a preterm infant is delivered by caesarean section rather than vaginal delivery, the amount of blood transfused via delayed cord clamping is less than desired, prompting a resurgence of interest in umbilical cord milking.   
      Anup et al. (doi:10.1542/peds.2015-0368) report this week on a two-center trial to see if preterm infants randomized to get one technique or the other show better systemic blood flow with one of these two methods used for both vaginal and caesarean section deliveries.   While no differences were noted regardless of method used for vaginal deliveries, umbilical cord milking appears to be statistically better for improving systemic blood flow in the setting of a caesarean section. So is this study enough to change current recommendations for delayed cord clamping?   
      You will want to also read the commentary by Drs. Tarnow-Mordi and Soll (doi: 10.1542/peds.2015-1545) that accompanies this study to determine whether this study resolves the best method for placental transfusion or not.  Which method do you prefer and why?  Will this study convince your local obstetrician to milk the cord rather than delay in clamping it?   
     Share with us your thoughts and practices with a response to this blog, an e-letter or a posting on our Facebook or Twitter sites.

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Wednesday, May 27, 2015

The Glycerin Suppository: Friend or Foe of the Preterm Infant


By: Lewis First, MD, MS; Editor-in-Chief      

          We certainly see preterm infants being helped in evacuating meconium or in relieving abdominal distension due to retention of stool with the use of a glycerin suppository or enema.  So how effective are they—and are there any adverse effects we should know about?  
       Livingston et al. (doi: 10.1542/peds.2015-0143) have performed a meta-analysis of all glycerin suppository and/or enema studies.  Outcome measures reported include earlier passage of stool, easier transition to enteral feeds, as well as complications like bleeding and necrotizing enterocolitis (NEC) and mortality. So what does the systematic review of these studies show?  While some indicators might suggest the benefits of this medication, others do not—and there is even the suggestion that use of a glycerin suppository may increase risk of NEC in preterm infants.   
     Take a hard look at this study, and hopefully you’ll find that with or without the use of glycerin, when it comes to stooling patterns in preterm infants, everything will come out fine in the end.

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Tuesday, May 19, 2015

Two Strategies to Decrease Pertussis Transmission to Infants: Which One Is Preferred?


By: Lewis First, MD, MS; Editor-in-Chief     

     Given the reluctance to vaccinate children on the part of some parents, as well as issues with efficacy of the vaccine requiring boosters to maintain herd immunity, the burden of pertussis remains a global public health issue not just in this country but around the world, especially in young infants who have not yet been vaccinated fully.  To protect infants from pertussis transmission, two strategies have been proposed:  (1) vaccination of pregnant women with protection through passive passage of antibodies to an infant and (2) cocooning whereby parents, caregivers, and other close contacts are vaccinated to indirectly protect infant transmission by keeping the organism out of those in close proximity to the infant.   
     So which strategy is better?  You’ll have to read a special article by Forsyth et al. (doi: 10.1542/peds.2014-3925) who reviews the evidence for both and arrives at the conclusion that vaccination during pregnancy is the preferred way to protect infants with cocooning as the backup plan.  Doctor Mark Sawyer and Doctor Sarah Long offer their own infectious disease expertise in an accompanying commentary (doi: 10.1542/peds.2015-0770) to further stress the import of making sure Tdap is given to every pregnant mother-to-be. 
      Take a shot at reading both the special article and commentary and in turn, don’t forget to tell pregnant mothers in your practice to get their Tdap if they haven’t already.

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